Provider Demographics
NPI:1578253522
Name:RILEY ROSE REFLECTIONS, LLC
Entity Type:Organization
Organization Name:RILEY ROSE REFLECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RA'EESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SADAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-918-3034
Mailing Address - Street 1:6531 S WOODLAWN AVE UNIT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-5477
Mailing Address - Country:US
Mailing Address - Phone:312-918-3034
Mailing Address - Fax:
Practice Address - Street 1:6531 S WOODLAWN AVE UNIT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-5477
Practice Address - Country:US
Practice Address - Phone:312-918-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty